Typical day for a Home Health nurse... - page 3

Not a bad day today... started back per diem today. 6 cases, all in the same township. Not my usual zip codes though, so I did waste some time and scheduled visits akimbo, instead of in a line like I usually try to do. 8:00am... Read More

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    Thanks for the bump.

    Hey, it has been five weeks and I am still in love with this job! We just finished JCAHOand did really well...94. They got us on those darn abbreviations we aren't supposed to use anymore. The rule is an "all or nothing" rule. If anywhere in any chart they pull there is an unauthorized abbrev. (lol) you get dinged for it.

    And, just to make the soup even spicier, ODH came in at the same time. But- WE GOT A 100%!!! WOOT!!!
    I haven't been here that long, but I feel like I helped a little.

    I have been "Case Managing" two of the patients I see and am starting to get the hang of what this means. One is a 65 y/o lady w end-stage COPD. She is reall Hospice material, but she says she just isn't "ther" yet , mentally. She is a retired RN ans we bonded immediately. She takes methyltrexate and gold injections for her arthritis and couldn't get out of the house for her shots d/t feeling so dyspneic. I really hated to see her give up the shots when they are just starting to help her. So I made numerous phone calls to obtain the serum and an order to give the shots. She was really happy about this and I felt great that I was able to help her out. Isn't this what is cool about HH?

    The other one is a total knee, female, 77. Lives w 79 y/o husband. She is doing great and her sister goes to her home every day to help her. This pt. has the beginnings of Alzheimers too. Well, I told the sister last Friday I felt the pt could be released from HH next week. So of course over the weekend, she thought her knee was swollen and hot. I think they are just nervous about being released from our care. So we have her for another week or so, and then will have to let her go.

    I have seen some really neat machines in patient's homes, too. A CAD cassette for IV infusion, and a cool pill machine that you fill little cups with pills, snap on a lid and drop it into the machine. It dispenses the cups at the right time of day and "talks", telling him "It is 8 AM and time to take your medicine." It even changed time automatically w Daylight Savings time.

    I just drive around from patient to patient, (enjoying my new car, BTW) and saying to my self, "I *love* this job!"

    I am taking a medical LOA for about 9 or 10 weeks. I sure hope I don't get stupid in that period of time. My manager knew I needed this time off when she hired me, so there is no problem there. She is even going to allow me to come in and do some chart reviews while I am unable to see patients. Nice! (I am having my ankle operated on tomorrow and will be in a cast for 9 weeks, unable to drive.)

    So how is everyone else doing??????
    Candimk2 likes this.
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    Oy! I have had the crud for over 3 weeks now. Working in the cold wet snow last week did nothing to help me!!

    Yesterday, I woke up, saw the cold rain, and called out. Thank goodness it was mild and sunny today, so I worked. I think I was punished for calling in sick...

    I had 2 news admits and three re-visits. 14 mile total mileage.

    Called one of the revisits b/c I was to teach the sister to draw up the insulin. She waas not able to make the appt, and since he had enough syringes drawn up and FBS was 120, I told him we'd be there wed at the latest. (Did not tell the supervisor of the opening...sssshhhh, I only do this when I feel like doo doo!)

    Next re-visit, a wound, no biggie, simple visit.

    Next re-visit, in a roach motel (aka high-rise bldg) was a daily wound. She attempted to refuse visit yesterday, why I don't know and why nurse pushed for visit I don't know, but when I got there today (no phone of course, so I had to make the trip) she "wasn't home, but the person ansering the door would only crack it open, like she didn;t want me to see inside. I'm thinking Hey lady, you don't have to tell me twice...LATER!!!!

    First new admit. OMG, obese lady with gigunda breasts, s/p cabg. No mentions of open wounds/wound care on referral. (see where I am going w this?) I get there she can barely stand, has diff ambulating, is crying in pain, and person in home was snapping at her, and got hostile w her b/c she asked him to clear a space for me to sit (major clutter and junk on the floor, this place hasn't seen a vacuum in a dozen years)

    She says she is having CP, aka incision, plus arthritic pain in shoulders. She needs more celebrex, but no Rx given, only thing that helped her pre-op.

    She has to beg to get a glass of water, which finally I just went inot the kitchen and got for her, avoiding the hostile one. was a little afraid to have too open of a conversation w her d/t this semi-scary dude over-hearing and possibly over-reacting.

    She can't even put pain pill into her own mouth, I have to put it in, along w her other am meds, and hold the water to her lips.

    At this point, it is clear that the 4 wounds I discovered will not be able to be taught to this CG, pt can't reac/see areas, and this lady is not appropro for HH. I tell her as much, and she cries, saying her son won't lift a finbger to help her. I explain that due to her pain (figured we could play the CP card, even tho I know it was incisional pain) and call 911, and I could speak to the docs and try to get her re-admitted so she could 1 get the assistance she needs, 2 get her meds, 3 get her drsg's changed, and 4 get her meals and adl's met.

    She absolutely refused this. This baffles me. I mean I know it is depressing to go back to the hospital, but isn't risking sitting in your own poo kind of depressing too?? I do not pass judgement on the pt, but I do think to myself, well, you made this choice, so now you have to live w it.

    Her breats were so HUGE, there was no way she could hold them up to even look at her would in a mirror d/t her arthritis. This teensy area btw the breasts that was not healing, gushed a cup of serosang fuid when I did lift them to do the drsg change. I was grossed out w this cold and all. But no odor, and clear fluid. It won't be long before she gets and infection in this environment and unable to control sugars, and she will be septic. She never told anyone what home situation waas like, if she had, they probably would not have d/c her to home.

    So urgent MSW referral made, per our policy, they do NOT want US to call APS, they want all communication to go thru MSW. I am OK w this b/c all APS would have done on Sunday is offer her the same options I had, and she had already refused that.

    Also PT and HHA. RD may be needed at a later date, but her RBS was 149, so not too bad.

    I documented that she was probably not appropriate for HH< but that "ethically, SN felt that assistance offered by VNA was better than no assistance." I did of course call the sup, but d/t lurking mean guy, I was afraid to discuss this IN the home w sup, so I had no choice but to commit. I'll probably catch some heat for this one!

    Next admit, a sweet LOL, clean neat house s/p CHF. She has complete faith in her docs. Takes meds as directed on bottles, and has no idea what any of these meds are for, despite the fact that she has been taking them for 2 years or more. Teaching started. But you know how you can't always tell if someone is wifty on the first visit? I have a gut feeling we may have a little wiftiness going on here, that will come out eventually. She has a caring involved dtr, but she couldn't be there today. We'll see how this develops.

    Just wated to share this one b/c of the ethical dilemma. What would you guys have done in my place?

    PS Sun, thanks for the bump, you think I should stick this one too?

    Reg, glad you are enjoying it!
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    Just wated to share this one b/c of the ethical dilemma. What would you guys have done in my place?

    PS Sun, thanks for the bump, you think I should stick this one too?
    1) yes, stick it....
    2) couldn't she have been admitted for rehab? shoulda been soon enough after hospital d/c to still get in , right?
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    She came from 3 weeks of rehab. They are usually pretty good there about finding placement or being certain someone is d/c to a safe environment, but in this case, the lady didn't speak up. I asked her about it and she said, I didn't say anything, they just came in and told me I was being d/c'd. I KNOW they give people like 4 days warning in that place, but I also understand that not everyone thinks they have a choice, so they don't speak up.

    OK, I'll stick it.
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    oooooooh.. I'm so jealous !

    I just started reading all these posts (gee, didn't even know this thread was here 'til I decided to take a closer look at the HH Forum..) :imbar

    This is definately my type of nursing ! No FAIR !!! Please keep this thread fluid, because I really do want to check it dailey.. it is a marvelous way to learn SO MUCH about HH nursing.. will definately give me a heads up for when I decide to go through with this in the future. I LOVE this thread !!! WONDERFUL !

    Thanx, Guys !
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    Hhhhmmm....it's been a non-eventful week.

    I did have one challenge though. A swet lady w breast CA, had a lumpectomy in the past, had chemo & rad, then a year later found a spot on the underside of her breast, it would have been very hard for her to see it.

    Anyway, it was necrotic by the time she got to the doc, he cut out the dead tissue and orgered granulex spray (I hate that stuff) a spray wound debrider, b/c there was a lot of slough inside, and that sucker was deep too! Then we were to pack w iodophor packing and cover w 4x4.

    I didn't like this wound care the first time I saw her about 1 1/2 weeks p admit, then I saw her again this past Sunday and mentioned it to our wound care "expert" not certified, but she is the be all end all of wound knowledge, and she suggested having her sit inn a shower chair and really irrigate it in the shower, then pack w hydrogel-impregnanted gauze and a covaderm. We were thinking she may be able to do that herself for a day in between visits, we are seeing her daily.

    So, not wanting to step on her CM toes, I had left her a VM saying it's been 3 weeks, and although the wound measures the same, it looks worse. Her CM agreed and spoke w surgoen Friday, who arranged for a stat wound care center consult (stat = next day) and she went today. I am curious to know how they changed it.

    The other lady above that I talked about, had her sternotomy opened by the surgeon, I knew that sucker wasn't healing beneath that pinpoint hole. It's not too deep and fortunately very healthy-looking and will probably heal well now. She has an attitude tho, man! Like everyone else needs to take care of her and she is completely unwilling to help herself do anything. She met w MSW and she is on the list for a senior living center now.

    I was extremely aggravated today by scheduling issues, but I am too tired to type all that out, maybe another day!

    The good part is the patients, the rest of it, the paperwork and my particular agency....no comment!
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    Hoolahan and all other HH nurses: Just wanted to say "Hi!" I have been on medical leave and don't have stories to tell right now. I sure miss working and miss my patients!

    Have a Great Nurses' Week!
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    Keep 'em coming ! I'm reading, I'm reading !!!

    THANX !
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    Gotta vent!! GRRR!! Teenager with pilonidal sinus and an attitude! She screamed her bloody head off as I was trying to pack it. I backed off...shouldn't have done so....she decided she didn't want me touching her again. It was a VERY small opening, but the sinus was fairly deep, judging by the amount of ribbon I removed.

    She wanted ANOTHER nurse to come in, claimed i was incompetent, inexperienced, didn't know what i was doing, yadda, yadda.... She asked for 2 of our nurses who weren't on duty tonight. Worst part of it is, when I spoke to management, THEY called up one of the nurses she wanted, and persuaded her to go and do a visit, even though she was off duty!

    (Sigh!) Boy, not looking forward to trying to explain THIS to CCAC when I ask to get an extra visit approved!

    After that, which took over an hour for a call that SHOULD have taken 15-20 min, I had to drive to the far east end of our territory to give a 1 mo. old baby a needle. She cried for about 5 seconds when I gave her the shot. Glad she's not a whiney teenager....

    In 5 years of community nursing have NEVER had anyone carry on the way that girl did, and believe me, I've done a ton of pilonidals/ abcesses/fistulas. One day, I admitted THREE in the same day!

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